Acute fulminating ulcerative colitis is a serious disease that carries a very high mortality. The acute attack may be an exacerbation of preexisting disease or it may represent the first manifestation of colitis in a previously apparently healthy person. In either case, the patient is acutely ill with high fever, diarrhea, bloody and purulent stools, and an overwhelming toxemia. There is often evidence of peritoneal irritation or frank peritonitis. Because these patients are so acutely ill, there has been a tendency to avoid surgical treatment, and, when it has become inevitable, simple ileostomy has been accepted as the operation of choice.1 The results of this therapy have been poor, and the mortality has ranged from 20 to 60% in reported series of cases. In analyzing the deaths that have occurred in the past, certain facts become apparent: 1. The majority of patients show evidence of severe blood and protein
Ripstein CB. PRIMARY RESECTION OF THE COLON IN ACUTE ULCERATIVE COLITIS. JAMA. 1953;152(12):1093–1095. doi:10.1001/jama.1953.03690120009003
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